Beth Israel Lahey Health Performance Network is a provider organization that is certified as a “risk-bearing provider organization” (RBPO) by the Massachusetts Division of Insurance. An RBPO is a group of health care providers that work together to coordinate patient care and enter into financial agreements with insurance companies to do so, thereby sharing financial risk.
Under Massachusetts law, patients with commercial insurance whose primary care provider, also commonly called a PCP, participates in an RBPO have the right to make an appeal and use an appeals process to resolve an issue. Beth Israel Lahey Health Performance Network considers patient appeals such as:
- Referral restrictions
- Type or intensity of treatment or services
- Timely access to treatment or services
- Other concerns about limitations of care
Appeals or complaints about insurance coverage issues should continue to be managed by your health insurer.
You can contact your primary care provider’s office to discuss the appeals process or to file an appeal. You can also choose a person (such as a spouse, family member, friend, attorney, or legal guardian) to act as your representative to help you with your appeal.